Law quickens health coverage decisions


State Senator Randy Gardner (right) with Dr. Robert Kose, past president of the Ohio State Medical Association, on the floor of the Ohio Senate Monday only minutes before Governor Kasich signed the Prior Authorization Reform Act, to help medical providers and patients get faster insurance coverage decisions.


Courtesy photo

COLUMBUS – One of the most comprehensive patients advocate bills in the nation was signed into law at the Statehouse Monday by Governor John Kasich.

Senator Randy Gardner (R-Bowling Green) sponsored Senate Bill 129, known as the Prior Authorization Reform Act, to require faster turnaround times for patients and medical providers to receive health care coverage decisions from insurance companies.

“This bill begins a new era when patients can receive health care in a more timely manner – the same health care they expect, deserve and have paid for,” Gardner said Monday. “We need a more modern, accountable and cost-effective prior authorization process in Ohio. Soon we will.”

Nearly 80 health care providers and patient advocate organizations, including the American Cancer Society, the Multiple Sclerosis Society, several mental health organizations, the Cleveland Clinic, and numerous other hospitals supported the bill. The lead supporting organization, the Ohio State Medical Association, said the bill is one of its top priorities during the current session of the General Assembly.

“Senate Bill 129 has a number of provisions that will make the prior authorization process more transparent, more fair, and more patient-focused,” said Tim Maglione, senior director of government relations for the OSMA.

Highlights of Senate Bill 129’s numerous reforms:

• Requires a new electronic web-based prior authorization process designed to end the costs and time lost with the current fax and phone call system.

• Provides for a 33 percent reduction in the time allowed for insurers to decide prior authorization requests and a 67 percent reduction in decision time for appeals of denied requests.

• Mandates that insurance companies disclose to medical providers all necessary information and documentation that a provider must submit in order for the request to be considered complete.

• Prohibits the practice of insurance companies retroactively denying payment for approved prior authorization requests after the surgery, service or medication is provided.

• Requires that insurers provide a 12-month prior approval for medications to treat some chronic conditions.

“The arguments that these reforms might increase insurance costs are unfounded,” Gardner said. “A better, faster prior authorization process can be more cost-effective for everyone involved, and the bottom line is that it is better for patients.”

The web-based prior authorization system must be established by 2018, while many of the other provisions of the bill will take effect in January of 2017.

State Senator Randy Gardner (right) with Dr. Robert Kose, past president of the Ohio State Medical Association, on the floor of the Ohio Senate Monday only minutes before Governor Kasich signed the Prior Authorization Reform Act, to help medical providers and patients get faster insurance coverage decisions.
http://aimmedianetwork.com/wp-content/uploads/sites/45/2016/06/web1_gardner-bill.jpgState Senator Randy Gardner (right) with Dr. Robert Kose, past president of the Ohio State Medical Association, on the floor of the Ohio Senate Monday only minutes before Governor Kasich signed the Prior Authorization Reform Act, to help medical providers and patients get faster insurance coverage decisions. Courtesy photo